Screening around a COVID-19 cluster: Exploring its impact on a local virus outbreak.

OBJECTIVE: In March 2020, we implemented screening of the contacts of a COVID-19 cluster having occurred in the Lot-et-Garonne department, the first department of the Nouvelle-Aquitaine region to be affected by the active circulation of SARS-CoV-2. We aimed to describe the impact of this screening on the local SARS-CoV-2 outbreak. METHODS: All high-risk contacts, as well as the individuals living in their households, were screened. We detailed the evolution of the number of confirmed COVID-19 cases in the Lot-et-Garonne department and the rest of the Nouvelle-Aquitaine region. RESULTS: Among the 89 screened individuals, 10 new cases were confirmed, including 4 asymptomatic persons. In Lot-et-Garonne, the number of confirmed COVID-19 cases immediately decreased after this screening and no epidemic peak occurred, contrary to what was observed in the rest of the region. CONCLUSION: The early screening of high-risk contacts of COVID-19 cases and members of their household implemented a few days before the first lockdown probably helped to prevent the spread of the virus in the department.

[Sexual health management in oncology]. / L'intervention sexologique en oncologie.

The cancer and its treatments have consequences on the intimacy and the sexuality of the patients and their partners. Supporting them with valid information, by spotting risk factors, warning complications, and by bringing answers to the often commonplace concerns of the patients, is an ethical duty. This intervention concerning the sexual health is collectively realized by all the healthcare professionals, in an organization of gradual answer, and benefits ideally from the clinical and educational expertise of sex therapists associated to the supporting care offer.

[The personalized health care process in oncosexology: a new health care offer in the service of both patients and health carers]. / Le parcours personnalisé de soins en oncosexologie : une nouvelle offre de soins au service des soignés et des soignants.

The sexual problematic linked to both cancers and their treatments remains underestimated by health carers especially since patients dare not speak about it. The oncosexology is a new offer of health care responding to an epidemiological reality, a strong demand, a care quality process and a societal demand of ethical, technical and humanist medicine. It aims at conciliating the oncological and quality of life objectives because sexual health belongs to oncological care and quality of life belongs to well-being for a majority of people/couple. By comparison to the pain situation of 20 years ago, a proactive politics is necessary to change the individual level to a collective one by modifying the attitudes of patients and… health carers, that is, by breaking the silence, by legitimating the demand and by allowing all the actors to be open about it. The optimal strategy for actualizing the "software" of physicians, who are the main factor of resistance, consists in simplifying and professionalizing the oncosexology by responding to the needs for information and offer visibility for all, and training for the most sensitized or involved carers. The term oncosexology should not shock. This new competence in supportive care corrects a real inequality of access to health care and fits in with a medical humanism by promoting a more personalized approach as much initially as in follow-up: a) to inform about sexual risks and sequels is an ethical and legal duty, b) the therapeutic strategy may be influenced by the iatrogenic sexual risk, which is frequently treatment-dependant, c) the impact and demand evolve throughout the health care process, d) multidisciplinary solutions exist according to the demand and its simple or complex nature, e) the impact is often positive for the patient/couple.

Characteristics and management of acute ST-segment elevation myocardial infarctions occurring in ski resorts in the French Alps: Impact of an acute coronary care network.

BACKGROUND: Compliance with guidelines for the management of ST-segment elevation myocardial infarction (STEMI) may be difficult in hard-to-access areas. AIMS: to analyse the characteristics, management and outcome of STEMIs occurring at altitude in the French Alps and managed by mobile medical emergency units. METHODS: From January 2006 to December 2008, from the prospective RESURCOR registry, 114 patients with a STEMI of less than 12 hours' duration, occurring in a ski resort or at high altitude and managed by the RESURCOR care system, were identified. Baseline characteristics, treatments and in-hospital outcomes were analysed. RESULTS: Ninety-three per cent of patients were men; the mean age was 57 years. STEMIs occurred during or less than 1 hour after physical activity in 76.3% of cases (mainly during or after alpine/cross-country skiing). Killip class greater or equal to 2 and cardiac arrest were observed in 35% and 7.9% of cases, respectively. Fifty-two (45.6%) patients underwent thrombolysis and 62 (54.4%) had percutaneous coronary intervention (PCI). Median delays were: first call to treatment, 82 min (17-230 min); symptoms to treatment, 165 min (52-770 min). All delays were significantly longer for PCI than for thrombolysis. First call to treatment delay was less than 120 min in 98.1% of patients who underwent thrombolysis and in 51.6% who had PCI (P<0.0001). In-hospital survival was 96.5%. CONCLUSION: Altitude STEMIs happen mainly during sporting activities. Clinical presentation is often severe, but an emergency coronary care network allows rapid reperfusion. These findings emphasize the need for an efficient network for STEMI management in geographically difficult-to-access areas.